Benign prostatic hyperplasia: the most effective dietary supplements

Benign prostatic hyperplasia (BPH), also called prostate adenoma, is a noncancerous enlargement of the prostate. It primarily affects older men, with prevalence increasing after age 40 and reaching up to 40% of men after age 70. BPH is often related to hormonal changes with age, particularly an increase in the production of dihydrotestosterone (DHT), a derivative of testosterone that stimulates proliferation of prostate cells. This prostate enlargement puts pressure on the urethra, causing bothersome urinary symptoms such as difficulty urinating and frequent urges.

Causes of BPH

The development of BPH is mainly influenced by age-related hormonal changes, notably an increase in dihydrotestosterone (DHT), a derivative of testosterone. DHT stimulates prostate cell proliferation, leading to progressive enlargement of the prostate. The conversion of testosterone to DHT is facilitated by the enzyme 5-alpha-reductase, a frequent target of drug treatments for BPH. In addition, increased estrogens in older men, due to conversion of testosterone by the aromatase enzyme, can also contribute to this growth.

Symptoms

The symptoms of BPH are mainly related to urethral obstruction caused by prostate growth. They can be divided into two categories: • Obstructive symptoms: difficulty starting urination, decreased urine flow, sensation of incomplete bladder emptying. • Irritative symptoms: frequent urges to urinate, urgent need to urinate, especially at night. These symptoms can be evaluated using the International Prostate Symptom Score (IPSS), a questionnaire that assesses the severity of urinary problems and their impact on quality of life. This score helps doctors decide on the appropriate treatment.

Diagnosis

The diagnosis of BPH is based on several steps. The physician begins with an interview to assess the discomfort experienced, often using the IPSS. Next, a clinical examination is performed, notably the digital rectal exam, which allows palpation of the prostate to assess its size and consistency. Additional tests such as renal-vesico-prostatic ultrasound, urinary flowmetry, and PSA (prostate-specific antigen) testing help rule out prostate cancer or other conditions.

Treatments

Treatment of BPH is tailored according to symptom severity. It may include lifestyle changes, medications, or surgical interventions in more severe cases. • Lifestyle and dietary changes: It is recommended to increase fiber intake to avoid constipation, reduce alcohol and spicy foods that may irritate the bladder, and maintain regular physical activity. • Medications: Alpha-blockers, such as Urorec or Silodyx, facilitate urine flow by relaxing the muscles of the prostate and bladder. 5-alpha-reductase inhibitors, such as Avodart, reduce prostate volume by blocking the conversion of testosterone to DHT. Finally, plant extracts, such as Permixon, are sometimes used, although their effectiveness is variable. • Combination treatments: Combining an alpha-blocker with a 5-alpha-reductase inhibitor is often more effective than monotherapy for reducing symptoms and preventing complications. • Surgical treatments: When medications are insufficient or if the prostate is very large, procedures such as transurethral resection of the prostate (TURP) or adenomectomy may be considered. For less severe cases, laser or thermotherapy treatments are less invasive alternatives.